Use of Lean Six Sigma Methodology in the Breast Imaging Service to Improve Patient Flow

Purpose: With about 40 million screening mammography (MG) procedures performed in the United States, it is anticipated that 10% of those instances require additional workup to determine if the lesion is cancerous or not, a process known as time to resolution (TTR). Patient flow in breast imaging services is highly variable, changing based on whether the patient requires extensive testing or not, which contributing to clinic inefficiencies. As a result, we used Lean Six Sigma Methodology (LSSM) in our breast imaging service at a publicly funded tertiary referral hospital to minimize TTR and enhance patient flow, hence improving efficiency and patient outcomes.

Methods/Materials: The combined LSSM is used in our PI project to combine the benefit of the visual outline provided by the Lean methodology with the structured process of Six Sigma, to reduce the wasted time resulting from variation in completion of the workup of screening recalls. An electronic medical record integrated system was put in place to track the TTR from the time the screening study is input until diagnostic resolution is reached. A baseline audit was conducted from September 1st, 2017, till April 30th, 2018. A post-implementation audit was conducted from October 1st to December 30th, 2019.

Results: 589 cases and 370 cases of mammographic recalls were made at the baseline audit and post-implementation audit, respectively. The TTR, in days, for the baseline audit and post-implementation audit respectively were: 102 vs 35 for BI-RADS 1&2, 103 vs 28 for BI-RADS 3, and 45 vs 40 for BI-RADS 4&5. To note, the baseline audit had a BI-RADS 6 population with a TTR of 72 days, while the post-implementation had no patients in that category. Plus, 111 and 99 patients did not complete their workup for the baseline audit and post-implementation audit, respectively.

Conclusions: Following the performance improvement, the TTR was reduced in all categories in the post-implementation audit, moving closer to our target of 35 days. Our team has successfully managed to bring the TTR down using lean six sigma methodology. This was made possible when the team adopted the patient-centric map, knowing the impact of BI-RADS outcome on patients’ lives.